{
"Npi": {
"NPI": "1265581383",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "INGRAM PEDIATRICS, P.A",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4100 SOUTH HOSPITAL DRIVE",
"SecondLineMailingAddress": "SUITE 302",
"MailingAddressCityName": "PLANTATION",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33317-2838",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "954-321-1591",
"MailingAddressFaxNumber": "954-321-1592",
"FirstLinePracticeLocationAddress": "4101 S HOSPITAL DR",
"SecondLinePracticeLocationAddress": "SUITE 12",
"PracticeLocationAddressCityName": "PLANTATION",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33317-2857",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "954-321-1591",
"PracticeLocationAddressFaxNumber": "954-321-1592",
"EnumerationDate": "01/09/2007",
"LastUpdateDate": "06/16/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "INGRAM",
"AuthorizedOfficialFirstName": "DEBORAH",
"AuthorizedOfficialMiddleName": "E",
"AuthorizedOfficialTitle": "PHYSICIAN/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "954-321-1591",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "ME79116",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}